International Journal of Africa Nursing Sciences 15 (2021) 100345

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International Journal of Africa Nursing Sciences

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Prevalence and associated factors of anemia among pregnant women

attending antenatal care at Felegehiwot Referral Hospital, Bahirdar City:
Institutional based cross- sectional study
Nurhusien Nuru Yesuf a,*, Zelalem Agegniche b
a
Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
b
Gynecology and Obstetrics Department, Dembia District Hospital, Gondar, Ethiopia

A R T I C L E I N F O
A B S T R A C T
Keywords:
Introduction: Anemia is a major public health problem in the world. Various studies in Africa have reported a high
Prevalence
Anemia
prevalence of anemia among pregnant women. Even though it is routine to screen pregnant women for anemia
Bahirdar during antenatal care, studies are done to assess the prevalence and associated factors of anemia among repeated
Ethiopia antenatal care visitors in the study area are limited.
Objective: To assess the prevalence of anemia and its associated factors among pregnant women who had repeated
antenatal care visits at Felegehiwot Referral Hospital from September-December 2019.
Methods: Hospital-based cross-sectional study was conducted in Amhara regional state, Felegehiwot Referral
Hospital, Bahirdar city, Ethiopia. A total of 286 pregnant women were selected using a systematic random
sampling technique. Structured and pretested questionnaires were used to collect data. Multivariable logistic
regression analysis was fitted to identify factors associated with anemia during pregnancy. Adjusted odds
ratio (AOR) with the corresponding 95% confidence interval (CI) was used to show the strength of
associations and variables with p-values of < 0.05 were considered as statistically significant.
Results: The overall prevalence of anemia among pregnant women who had repeated antenatal care visits at
Felegehiwot Referral Hospital was 20.9%. Hookworm infection {AOR = 22.9: (95% CI (2.89, 181.57)), rural
residence [AOR = 6.26; (95% CI 1.90, 20.71)), history of malarial attack [AOR = 19.62; (95% CI 3.93. 97.8)),
lack of green leafy vegetables [AOR = 7.94; (95% CI 1.1, 56.4)) and ≥ one extra meal in ≤ 4 days per week [AOR
= 15.7; (95% CI 4.26, 58.06)) were significantly associated with anemia during pregnancy.
Conclusion and recommendation: In the present study anemia among pregnant women is found to be a
moderate public health problem. Multiple factors including multiparty and living in rural areas were
associated with anemia during pregnancy. Therefore, preventive strategies to prevent anemia during
pregnancy particularly for multiparous mothers and mothers living in rural areas are imperative.

1. Introduction
World health organization (WHO) defined anemia as a hemoglobin
concentration below 11gm/dl in pregnancy. It is a global public health
problem affecting pregnant women living in both developed and
developing countries and a common phenomenon among pregnant
women in the developing world (Organization, 2017).
According to updates from the WHO database, half of pregnant
women and one-third of non-pregnant women in the world suffered
from nutritional anemia. It estimated that 35–75% (56% on the
average) of pregnant women in developing countries and 18% of
women from
industrialized countries were anemic (Ghanaian, 2007).
Women who are pregnant encounter health problems ranging from
minor disorders of pregnancy to major complications like severe
anemia that may end up with severe maternal and fetal morbidities and
mor- talities (Agampodi, Wickramasinghe, Horton, Agampodi, &
Dastgiri,

Abbreviations: ANC, Antenatal Care; APH, Ante Partum Hemorrhage; G/dl, Gram per Deciliter; Hg, Hemoglobin; HIV, Human immune deficiency Virus; IUGR,
Intrauterine Growth Restriction; LNMP, Last Normal Menstrual Period; MDG, Millennium Development Goals; MMR, Maternal Mortality Rate; PCA, Principal
component Analysis; PMTCT, Prevention of Mother to Child Transmission; SPSS, Statistical Package of Social Sciences; WHO, World Health Organization.
* Corresponding author.
E-mail address: yesufnur935@gmail.com (N. Nuru Yesuf).

https://doi.org/10.1016/j.ijans.2021.100345
Received 26 November 2020; Received in revised form 27 July 2021; Accepted 1 August 2021
Available online 4 August 2021
2214-1391/© 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
N. Nuru Yesuf and Z. Agegniche
2013). These problems are rampant in developing countries like
Ethiopia. Surprisingly the maternal mortality rate in Ethiopia is high.
This makes this country one of the five countries that together account
for 50% the of world’s maternal death (Ejigu, Woldie, & Kifle, 2013;
Obse, Mossie, & Gobena, 2013).
Studies done in different parts of the world revealed anemia as a
significant factor for maternal mortality. Globally up to 20% and much
more were reported in developing countries like Pakistan and Nigeria
(Uneke, Duhlinska, & Igbinedion, 2007).
In Ethiopia anemia is the most frequent morbidity among pregnant
women ranging from 21.6% to 53.9%(7, 20, 21). According to the
Ethiopian demographic and health service survey report in 2011, 17%
of women of reproductive age were anemic (Demographic, 2011).
Multiple factors including inadequate intake of iron, poor absorp-
tion, parasitic infections from hookworm and malaria, genetic red cells
diseases, infection from HIV/AIDS, blood loss from menstrual irregu-
larities, bleeding during pregnancy and childbirth, and closely spaced
birth intervals were the major contributory factors anemia during
pregnancy in developing countries (Shaw & Friedman, 2011).
The government of Ethiopia is implementing several health care
strategies to reduce maternal and child mortality. Health promotion,
prevention and care provision during pregnancy and, childbirth are
focus areas of antenatal care in Ethiopia (Berhan & Berhan, 2014).
Therefore, conducting studies to assess prevalence during pregnancy
and its associated factors is an important aspect of maternal health care
to improve the quality of antenatal care in the country.
Similar studies were conducted on the prevalence and associated
factors of anemia during pregnancy in Ethiopia. Pregnant women who
have repeated antenatal care visits are expected to be less likely to be
anemic. This may be from better access to health information and
through the provision of effective health care interventions during their
ANC visit. This in turn reflects the quality of antenatal care provided
in the setting. However, studies done to assess anemia among repeated
visitors of antenatal care in the area are limited.
Therefore this study helped to address the prevalence and its asso-
ciated factors of anemia among pregnant women having repeated
antenatal care visits at Felegehiwot Referral Hospital of Amhara
region in Ethiopia.
2. Objectives
2.1. General objective
To assess the prevalence and associated factors of anemia among
pregnant women attending ANC two or more times at Felegehiwot
Referral Hospital, Bahirdar city, Northwest Ethiopia.
2.2. Specific objectives
To assess the magnitude and severity of anemia among pregnant
women who had repeated antenatal care visits at Felegehiwot Referral
Hospital from September to December 2019, Bahirdar city, Northwest
Ethiopia.
To identify associated factors of anemia among pregnant women
who had repeated antenatal care visits at Felegehiwot Referral Hospital
from September to December 2019, Bahirdar city, Northwest Ethiopia.
3. Methods and materials
3.1. Study design, setting, and period
A researcher used an Institution based cross-sectional study (a
study design commonly used to assess disease burden in a certain
community) to conduct this study at Felegehiwot Referral Hospital, a
referral hos- pitals in the region that provides preventive, curative, and
diagnostic services to Bahirdar city and its surroundings and serves
as a referral
2
International Journal of Africa Nursing Sciences 15 (2021) 100345
center to the western part of the region. This city is the central place of
the Amhara region found 567 Km in the northwest direction from
Addis Ababa, the capital city of Ethiopia. Bahirdar city is located at
11036′N 3723′ latitude and 11.600 N 370.383E longitude with a
tropical climate having an average temperature of 19 ◦C 1820 m above
sea level (Wikipedia). Its estimated total population in 2019 was
288,200 (CSA, Ethiopia 2007). Among these 147,397 (51.2%) were
female population and a total number of 9331 (3.24%s) women in the
reproductive age group were estimated to be pregnant. In the previous
year, more than five thousand pregnant mothers had antenatal care
follow at Felegehi- wot Referral Hospital. The study is an area where
outbreaks of malaria, an important risk factor for anemia, occur in the
rainy season of Ethiopia (June to July) and after the rainy season
(September to December) (Aschale, Mengist, Bitew, Kassie, & Talie,
2018). The study was con- ducted over a period of four months from
September to December 2019.
3.2. Study population and sampling procedure
All pregnant women who had repeated antenatal care visits at
Felegehiwot Referral Hospital were included in the study. The sample
size was determined by using a single population proportion formula
and the proportion was taken from the previous literature in Ethiopia.
According to a study conducted in Azezo health center, the prevalence of
anemia among pregnant women was 21.6. %. By considering 95%
confidence interval, 5% marginal error, and 5% non-response rate. The
final minimums adequate sample size was 286.
The study enrolled 286 pregnant women who had repeated
antenatal care visits at Felegehiwot Referral Hospital. Pregnant women
attending antenatal care for the first time during the study period were
excluded to see the effect of ANC follow-up on anemia during
pregnancy.
According to the data obtained from these hospitals in the last six
month prior to this study on average 46 pregnant women were
expected to have repeated ANC visits per day during the study period.
A sys- tematic random sampling technique was used to select study
subjects during the study period after calculating the Kth(N/n =
1012/286) value by dividing the total number of pregnant women who
were expected to have repeated antenatal care visit during the study
period to the required sample size and the first subject was selected by
lottery method.
3.3. Data collection tool, measurements, and quality management
A semi structured English version questionnaire developed from
different literatures was initially prepared in the English language and
translated into Amharic (local language) and again it was retranslated
back to the English language by a qualified language translator to
check for any in consistencies or distortions in the meaning of words
and concepts. The instrument was cheeked by experts in the field and
inputs were taken and corrections made accordingly. It was pretested
on 5% of
pregnant women who were not included in the study. Cronbach’s alpha
˃0.5 and multiple factor analysis (PCA) were also done to check the
validity and reliability of the tool. Two days of training were given to
one data collector (diploma midwife holder) and one supervisor (BSc
nurse) before the beginning of data collection. Data collector collected
the data at Felegehiwot Referral Hospital antenatal care clinic from
pregnant mothers who had repeated antenatal care visits by using the
interviewer-administered structured Amharic version questioners that
contain detailed questions comprising all the variables of the study.
The procedure of data collection was done parallel to the routine ANC
services.
Data on socio-demographic, obstetrical, gynecological, medical
conditions of the pregnant mothers and their dietary habit were
collected by the interviewer administrated semi structured Amharic
version questionnaire. Gestational age was determined by the medical
interns or general practitioner by using LNMP or obstetrical ultraso-
N. Nuru Yesuf and Z. Agegniche International Journal of Africa Nursing Sciences 15 (2021) 100345
nography. The data collector takes the measurements from the
medical record of pregnant mothers.

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N. Nuru Yesuf and Z. Agegniche International Journal of Africa Nursing Sciences 15 (2021) 100345

Hematocrit was determined by taking capillary blood through

Table 1
finger prick and hematocrit was estimated by Microhematocrit
Socio-Demographic and Economic Characteristics of pregnant women (n = 286)
determination method, and then converted to hemoglobin. A stool at FHRH, Bahirdar city, Northwest Ethiopia, 2019.
sample from all subjects was microscopically examined for hook
Variables Frequency Percent
worm infection using dilution method with sodium chloride solution
Age 15-19 13 4.5
within one hour of collection.
20-24 117 40.9
Data were checked for its completeness and accuracy during data 25-29 110 38.5
collection. Close supervision of trained data collector (diploma 30-34 8 2.8
midwife holder) was undertaken by the trained supervisor (one BSc >35 38 13.3
nurse). The supervisor strictly supervised the data collection process Residence Urban 178 62.5
Rural 108 37.5
and provided on-site advice and feedback to the data collector on daily
Marital Status Married 267 93.4
basis. There was daily exchange of information between the principal Divorced 10 3.5
investigator and supervisor. Husband died 5 1.4
Living separately 4 1.7
3.4. Data management and analysis Educational Status Unable to read and write 199 69.6
read and write only 48 16.8
Primary education and above 39 13.6
Questionnaires were checked daily for completeness and accuracy. Occupational Status Housewife 224 78.3
All data were double entered, cleaned, edited, coded, and entered into Private 7 2.4
EPI INFO version 3.3 and exported to SPSS version 16.0 for analysis Farmer Government 22 7.7
Employee 33 11.5
by the binary logistic regression model. Both bivariate and
Religion Orthodox 252 88.1
multivariable analyses were used to see the association of different Muslim 30 10.5
variables. Cate- gorical variables were summarized into percentages Protestant 4 1.4
and proportions. The continuous variables were summarized into Family Monthly Income Low 146 51
means, medians, stan- dard deviation, and ranges and the results were Middle 118 41.3
High 22 7.7
presented with tables and figures. The prevalence of anemia was
obtained by calculating the proportion of pregnant women whose
hemoglobin level was < 11gm/dl were multiparous. Surprisingly, more than one-third of them 107
out of the total number of pregnant mothers who had repeated ANC
(37.4%) had no history of use of contraceptives. prior to the index
visits in the hospital. Bivariate analysis was used to determine the as-
pregnancy (Table 2).
sociation between anemia and various independent variables including
socio demographic, obstetrical, gynecological, medical and dietary
5.3. Dietary habits of pregnant women for selected food items
factors of pregnant mothers. Continuous independent variables were
categorized and associations established using Chi-squared tests. This
About half of pregnant women 146 (51%) had a less frequent
was similarly done for categorical variables. An adjusted odds ratio
intake of foods from animal sources (≤4 days per week) and more than
with 95% confidence interval was used to measure the degree of
two- third 229(80.1%) of pregnant women had a more frequent intake
association between variables and P-value of < 0.05 was considered of coffee or tea within two hours after a meal (≥five times per week)
to be statisti- after meal. However, about one-third of them 90(31.5%) had habits of
cally significant during multivariable logistic regression.
eating one or more additional meal for most of the days in a week
(Table 3).
4. Ethical consideration
5.4. Laboratory findings
The proposal was reviewed and approved by the institutional
review board (IRB) of Gondar University Institute of Public Health
The overall prevalence of anemia (hemoglobin < 11gm/dl) was
and College of Medicine and Health Science before the start of the
study. The study was conducted in accordance with the ethical
Table 2
principles of the Decla- ration of Helsinki. Informed and written
Medical, gynecologic and obstetrics, and medical conditions of pregnant women
consent to participate in the study was taken from pregnant mothers (n = 286) at FHRH Bahirdar city, Northwest Ethiopia, 2019.
who met the selection criteria. Informed and written consent were
Variables Frequency Percent
taken from all pregnant mothers enrolled to participate in this study.
Gestational age (trimester) 1st trimester(<14 27 9.43
weeks)
5. Results
2nd trimester (14-27 187 65.4
wks)
5.1. Socio-demographic characteristics 3rd trimester (28-42 72 25.17
weeks)
A total of 286 pregnant women was enrolled in this study and the Parity Primigravida 155 54.2
Multipara 131 45.8
response rate was 100%. The mean age of the respondents was 25.7
Birth Interval (average) < 2 years 171 59.8
years with 1.05 years of SD. The majority of the mothers 267(93.4%), > 2years 115 40.2
were married, 178(62.21%) of them were urban residents. About two- Abortion Yes 37 12.9
thirds 199(69.6%) of them were unable to read and write and 252 No 249 87.1
Contraceptive injectable 140 49
(88.1%) of them were orthodox Christians (Table 1).
Oral pills 39 13.6
None 107 37.4
5.2. Gynecological, obstetrical, and medical conditions of pregnant Menstrual period prior to 1-8 days 225 78.7
women
index pregnancy >9 days 61 21.3

Among all study participants, 187(65.4%) and about one-fourth 72 (54.21%) were primigravida and the remaining 131(45.8%) of them
(25.17%) of them were in the 2nd & 3rd trimester of pregnancy
respectively. Additionally, more than half of pregnant women 155

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N. Nuru Yesuf and Z. Agegniche International Journal of Africa Nursing Sciences 15 (2021) 100345
Medical diagnosis Malaria 41 14.3
Intestinal parasite 36 12.6
Other 209 73.1
Antepartum hemorrhage Yes 8 2.8
No 278 97.2

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N. Nuru Yesuf and Z. Agegniche International Journal of Africa Nursing Sciences 15 (2021) 100345

Table 3
conditions. The odds of anemia were 2.43 times higher among multip-
Dietary characteristics of pregnant women (n = 286) at FHRH, Bahirdar city,
Northwest Ethiopia, 2019. arous pregnant mothers as compared to primigravida mothers.
Pregnant mothers who had a history of malarial attack were 19 times
Variables Frequency Percent
higher [AOR = 19.6 (95% CI 3.93, 97.6)] to be anemic as compared to
Diets (meat, poultry, milk, and its products) <4 146 51 those who did not have a history of malarial attack. Similarly, the odds
days
of anemia were 22 times higher [AOR = 22.9 (95% CI2.89, 181.57)]
>5 140 4
days among mothers with hookworm infection as compared to mothers who
Diets from green leafy vegetables <4 196 68.5 did pregnant not have an intestinal parasite (Table 5).
days Logistic regression analysis conducted to assess the possible rela-
>5 86 30.1 tionship between anemia and dietary habit of pregnant women showed
days
that anemia was significantly associated with eating one additional
Not at 4 1.4
all meal
Coffee or tea intake immediately after a meal <4 52 18.2 per day for greater or equal to 5 days per week [AOR = 7.94 (95% CI
days 1.1–16.4)] and eating green leafy vegetables for <4 days per week [AOR
>5 229 80.1 = 15.7 (95% CI 4.26, 18.06)]
days
Not at 5 1.7
all 6. Discussion
Fruits intake after meal <4 219 76.6
days Anemia among women of reproductive age particularly during
>5 9 3.1 pregnancy is a major public health problem and an important contrib-
days
Not at 58 20.3
uting factor for maternal and perinatal morbidity and mortality espe-
all cially in developing countries (Sabina, Iftequar, Zaheer, Khan, &
Eating one additional meal per day than non- <4 85 29.7 Khan, 2015).
pregnant state days In the present study, the prevalence of anemia is found to be 20.9%.
>5 90 31.5
This finding was in agreement with the study done in Azezo health
days
Not at 111 38.8
center (Alem et al., 2013). This might be due to the socio-demographic
all characteristics similarities of the study participants. However, the
prevalence of anemia observed in this study was not in agreement with
studies done Gilgel gibie dam area (53.9%) and Shalla wereda (36.6%)
20.9%. Surprisingly, 15(5.2%) of pregnant women were found to be (Obse et al., 2013). This difference might result from the socio-
positive for the HIV test and 39(13.64%) have hookworm infection demographic difference of the study populations. In this study major-
(Table 4). ity of the study, subjects were from urban areas 178 (62.5%) having
better information and access to health care services whereas 53.9% of
5.5. Prevalence and classification of anemia pregnant women who had antenatal care during the study period in
Gilgel gibie (Getachew, Yewhalaw, Tafess, Getachew, & Zeynudin,
The prevalence of anemia among pregnant women was 20.9%. The 2012) and 36.6% in Shalla woreda (Obse et al., 2013) were from rural
mean hemoglobin level was 10.93 gm. /dl plus or minus 0.41 SD. areas. Similarly, this study was not in agreement with studies done in
Severe anemia was identified in 4(6.6%) and the remaining 32 (53.4%) Nepal (77.6%), Nigeria (62.5%– 65%) (Idowu, Mafiana, & Sotiloye,
and 24 (40%) had moderate and mild anemia respectively (Fig. 1). 2008), and Kenya (69.1%) (Ouma et al., 2007). This may also result
from a difference in socio-demographic characteristics of the study
5.6. Factors associated with anemia during pregnancy populations and difference in time of studies.
The revalence of anemia among first-time antenatal care visitors is
Residence, parity, malaria, hookworm infection, and dietary habits high particularly during pregnancy resulting from lack of iron folate
including frequent intake of green leafy vegetables in their diet and supplementation and other focused antenatal care interventions and it
additional intake of meal during the index pregnancy were could have been less among repeated visitors (Sabina et al., 2015).
significantly associated factors with anemia. However, the present study revealed that anemia is still a prevalent
Logistic regression analysis was employed to assess possible re- health problem among repeated antenatal care visitors. This in turn
lationships between anemia and socio-demographic characteristics of reflects the low level of health care quality in our setting. The high
pregnant women. Anemia was significantly associated with rural resi- prevalence of anemia has significant consequences for human health as
dence [AOR = 6.26 (95% CI 1.90, 20.71)]. The odds of anemia were well as social and economic development in low and middle income-
6.26 times higher among pregnant women living in rural setting as countries (Sabina et al., 2015).
compared with their urban counterparts. (Table 5). From the current study, pregnant mothers who had a history of
Logistic regression analysis was done to see the relationship malaria attack were 19 times more likely to be anemic as compared to
between anemia during pregnancy and obstetrical, gynecological, and those pregnant women who did not have a history of malaria attack.
medical This finding was in line with a study conducted in Kenya (Ouma et al.,
2007) and Azezo Health Center in which 70% (Alem et al., 2013) of
Table 4 pregnant women who had malaria were anemic. This could be from
Laboratory findings of pregnant women (n = 286) at FHRH, Bahirdar city, their geographical location which has an important effect on the
Northwest Ethiopia, May 2013, December 2019. distribution of malaria in both of these tropical countries. Sequestration
Variables Frequency Percent of malaria parasites in the placenta avoids splenic clearance thus it
Hemoglobin Anemic (<11gm/dl) 60 21 makes pregnant women susceptible to malaria. Malaria causes anemia
Not-anemic (>11gm/dl 226 79 and low birth weight through a number of different ways including
Stool examination Hookworm 39 13.64 excess removal of non-parasitized erythrocytes, immune destruction of
Other intestinal parasites 18 6.29
parasitized red cells, and impaired erythropoiesis as a result of bone
No intestinal parasite 229 80.07
HIV test result Reactive 15 5.2 marrow dysfunc- tion that can result in maternal anemia and low birth
Non-reactive 271 94.8 weight (Guyatt & Snow, 2004).
This study also identified significant associations between
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 N. Nuru Yesuf and Z. Agegniche International Journal of Africa Nursing Sciences 15 (2021) 100345

Fig. 1. Prevalence and classification of anemia among pregnant women attending ANC at FHRH, Northwest Ethiopia, 2019.

hookworm infection and anemia during pregnancy. The odds of

Table 5
Bivariable and Multivariable Analysis of Factors Associated with anemia during
anemia were 22.9 among pregnant mothers who had hookworm
pregnancy attending ANC at FHRH Bahirdar city, North West Ethiopia, infection as compared to mothers who were not infected. This finding
December 2019. was consistent with a study finding done in Gilgel gibe dam area
(Getachew et al., 2012) and Azezo health center (Alem et al., 2013).
This may also result
Variables Anemia COR AOR
from the similarities in the distribution of the study population by their
(95% (95% CI)
Yes No
CI) residence and economic activities (rural residence and farming). In the
developing world, young women, pregnant women, and their infants
Residence Rural 39 69 4.22 6.26
(13.6) (24.1) (2.3, (1.90, and children experience intestinal parasitic infections especially due to
7.7) 20.71)* hookworm (helminthes) and it may induce deficiency of iron, total en-
Urban 21 157 1 1 ergy, protein, and possibly folate and zinc that can result in low birth
(7.4) (54.9) weight, IUGR and greater risk of prenatal morbidity and mortality.
Parity Multifarious 47 135 2.96 3.83
In addition in this study, there was a statistically significant associ-
(16.4) (47.02 (1.6, (1.29,
5.4) 11.43) * ation between anemia and rural residence. Pregnant mothers living in
Primigravida 13 91 1 1 rural areas were 6.26 times more likely to be anemic when compared
(4.54) (32.04) with their urban counterparts. This finding is consistent with the study
Malaria Yes 25 10(3.5) 15.43 19.62
conducted in Gilgel gibe dam area (Getachew et al., 2012). Pregnant
(8.74) (6.8, (3.93,
34.9 97.9) *
women living in rural areas have more risks of occupational exposure
No 35 216 1 1 to soil-transmitted helminthes through contact with soil contaminated
(12.24) (75.52 with human excreta resulting from inaccessibility and inappropriate
Stool exam Hook worm 28(9.8) 11(3.8) 6.62 22.9 utilization of latrine. Furthermore, lack of information on dietary di-
(1.9, (2.89,
versity and various dietary patterns or feeding practices and poor
22.9) 181.57*
Other 5(1.75) 13(4.5) 19.04 45(10.19,
implementation of preventive measures like wearing protective shoes
intestinal (8.5, 200) and hygienic practices among rural residents may augment the problem
parasite 42.5) (Organization, 2017).
No intestinal 27 202 1 1 In the present study, anemia was 3.83 times more prevalent in
parasite (9.44) (70.6)
Diets (meat, ≤4days /week 48 98 5.22 3.85
multiparous women than primigravidas. This finding was in line with
poultry, milk (16.8) (34.26) (2.63, (0.94, the findings a study done in Shalla woreda. An adequate supply of nu-
and its 10.37) 15.74) trients is required to maintain maternal nutritional depletion resulting
products) ≥5days/ week 12 128 1 1 from the cumulative effect of successive pregnancies and lactations. If a
(4.19) (44.8
new pregnancy starts before complete folate restoration, the woman
Coffee or tea ≤4days /week 57 139 11.34 7.94 (1.1,
intake after (19.93) (48.6) (3.44, 56.4) will be at higher risk of maternal anemia from iron and folate
meal 37.4) deficiency and subsequent adverse perinatal outcomes such as low
≥5days / week 3(1.05) 83 1 1 birth weight, pre- term birth, and small for gestational age (Conde-
(29.02) Agudelo, Rosas- Bermudez, Castan˜o, & Norton, 2012).
Note: Insignificant variable in crude analysis was omitted from entering in to the Finally, in the present study, the odds of anemia among pregnant
model and not presented on the table, * significant at < 0.05 α-values during women were 8 times higher among pregnant women who were taking
multivariate analysis. additional meals less frequently during pregnancy. Similarly less
frequent intake of green leafy vegetables was a significant factor
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8
N. Nuru Yesuf and Z. Agegniche
associated with anemia during pregnancy. The common source of iron
in developing countries is non-hem iron obtained from plant sources.
However, different factors in the food limit its bioavailability. A diet
containing a high amount of inhibitors and a low amount of enhancers
such as phytate will lead to decreased iron absorption. On the contrary,
absorption of non-hem iron is enhanced by the presence of other diet
components like ascorbic acid, organic acids, and foods of animal
origin in the diet (Organization, 2017).
7. Limitations of the study
Cross-sectional studies are not able to infer the temporal
relationship between cause and effect.
8. Recommendation
Prevention of disease, promotion of health, and provision of
obstetrical care as per national guidelines and nutritional policy of the
country (federal ministry of health of Ethiopia) for all pregnant women
attending antenatal care with periodic monitoring and evaluation of the
program (ANC) is imperative.
Researchers are also recommended to conduct a study on the wider
geographical area with strong study designs.
9. Conclusion
Anemia among pregnant women is found to be a moderate public
health problem in the study area. The prevalence of anemia was high
among rural residents and multiparous pregnant women. The study
identified that anemia during pregnancy is associated with hook warm
infection, rural residence, multiparty, history of malaria attack, lack of
taking green leafy vegetables, and one extra meal in ≤ 4 days per week.
Acknowledgments
The authors would like to thank the participants of the study for
their cooperation and Felegehiwot Referral Hospital staffs for their
support.
Author statement
NNY has contributed to the design, data collection, data analysis,
interpretation and manuscript development. ZA has contributed to data
collection, interpretation, and revision of the final manuscript. All
International Journal of Africa Nursing Sciences 15 (2021) 100345
authors read and approved the final manuscript.
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